Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: Chronic Heart Failure | Acute Heart Failure and Pulmonary Oedema | Loop Diuretics | Entresto Sacubitril with Valsartan | Ivabradine | Furosemide | Angiotensin Converting Enzyme Inhibitors | Cardiac Resynchronisation Therapy (CRT) Pacemaker |
Even a simple bedside echo can help in the diagnosis and treatment. Get one as soon as possible. Causes of flash pulmonary oedema include severe left ventricular (LV) dysfunction, paroxysmal arrhythmias, three-vessel or left main stem coronary disease, in the context of hypertension, renal artery stenosis and phaeochromocytoma. The initial assessment should include excluding/treating arrhythmia +/or acute mechanical problems +/or acute coronary syndrome
Initial Cardiogenic Pulmonary Oedema Management Summary |
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Common Precipitating Causes of Heart Failure | Clinical Information | Diagnostic Information |
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Myocardial ischemia or infarction | Sudden chest pain, shortness of breath, diaphoresis, nausea | ECG changes (ST elevation), elevated troponins, echocardiogram |
Atrial fibrillation or other supraventricular tachycardias | Palpitations, dizziness, fatigue, shortness of breath | ECG showing irregular rhythm, echocardiogram, Holter monitor |
Uncontrolled hypertension | Headache, fatigue, vision changes, chest pain | Elevated blood pressure readings, echocardiogram for left ventricular hypertrophy |
Valvular disease | Murmurs, shortness of breath, fatigue, dizziness | Echocardiogram, chest X-ray, Doppler studies |
Ventricular tachycardia | Palpitations, dizziness, chest pain, syncope | ECG showing fast, regular rhythm, electrophysiological studies |
Pulmonary embolism | Sudden shortness of breath, pleuritic chest pain, cough, hemoptysis | CT pulmonary angiography, D-dimer, ventilation/perfusion scan |
Pericardial disease | Chest pain, pericardial friction rub, hypotension | Echocardiogram, chest X-ray, ECG showing diffuse ST elevation |
Sepsis | Fever, chills, hypotension, altered mental status | Blood cultures, elevated lactate, complete blood count (CBC) |
Anemia | Fatigue, weakness, pallor, shortness of breath | Complete blood count (CBC), low hemoglobin, low hematocrit |
Poor dietary or medical adherence | Weight gain, edema, worsening shortness of breath | Weight monitoring, blood tests for electrolyte imbalances, medication review |
Adverse drug effects | Symptoms vary depending on drug, including arrhythmias, hypotension, or fluid retention | Medication review, blood tests, ECG for arrhythmias |
Hyperthyroidism or hypothyroidism | Fatigue, weight changes, palpitations (hyper), cold intolerance (hypo) | Thyroid function tests (TSH, T3, T4), ECG for arrhythmias |
Unknown/unexplained* | Non-specific symptoms such as fatigue, dyspnea | Comprehensive diagnostic workup including imaging and lab tests |
A reduced EF < 35% is a poor prognostic indicator and needs expert assessment and management
New York Heart Association (NYHA) Heart Failure Class Patient Symptoms | |
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I | No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnoea (shortness of breath). |
II | Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnoea (shortness of breath). |
III | Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnoea. |
IV | Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases. |
Batwing type pulmonary oedema